by Sandi James, MEd PGradPsych
What does trauma-informed care look like? When do we need to use trauma informed care?
The very first thing we need to have awareness of is just how common trauma is, and to recognise that almost every person who seeks treatment could have experienced at least one traumatic event in their life. We don’t always need to probe people about these experiences; instead, we need to assume that they may have this history and act accordingly. Trauma Informed Care (TIC) is appropriate for all our clients, regardless whether they disclose a trauma history or not. Care that is trauma informed involves prevention, recognition, and response to trauma-related difficulties. Experts agree that incorporating an awareness of trauma into medical care requires a systems-wide approach.
If a client has experienced trauma, medical or psychological offices can be a very scary place. Clients will often not volunteer information about prior experiences or might deny the existence of trauma. This usually happens as a result of fear, guilt or shame. Taking the time needed to build a trusting and therapeutic relationship is hugely important. Working with the client where they are at, while supporting them to take appropriate risks in therapy is equally important.
Trauma comes in many forms and impacts our clients in different ways. Different events can be experienced by different people in a wide variety of ways depending on how the individual experienced it and the impact it has on their nervous system. Being aware and present in session can help connect with the client and enable the clinician to “read” the clients non-verbal communication to enable you to be more compassionate and effective in practice.
It is also important to remember that there are many kinds of trauma, remembering again that each person’s experiences and reactions are individual. Trauma-informed care is the open-mindedness and compassion that all patients deserve, because anyone can have a history that impacts their encounter with the health care system.
We as providers need to realise that many patients have a history of physical, sexual, and/or emotional abuse, as well as serious illnesses and negative experiences in the medical setting, and we need to learn to respond with empathy and understanding.
Toxic stress can have severe adverse impacts on young people particularly. This is stress that is severe, unmanageable, and occurs in the absence of appropriate support. It can lead to physiological and psychological changes that permanently alter the makeup of the developing brain and other organ systems. It can also result in an overactivation of the stress response itself, creating a self-perpetuating cycle.
These are not the kind of tough knocks that build resilience. These are the ones that batter you down. Many individuals who seek treatment in behavioral health settings have histories of trauma. Despite this, they may often not recognize the effects of trauma in their lives; either they don’t draw connections between their trauma histories and their presenting problems, or they avoid the topic altogether. Likewise, treatment providers may not ask appropriate questions about a client’s history of trauma, may feel unprepared to address trauma-related issues proactively, or may struggle to address traumatic stress effectively.
Recognizing that traumatic experiences link closely into behavioral health problems, front-line professionals and community-based programs can begin to build a trauma-informed environment across the continuum of care. Key steps include meeting client needs in a safe, collaborative, and compassionate manner; preventing treatment practices that retraumatize people with histories of trauma; building on the strengths and resilience of clients; and endorsing trauma-informed principles in agencies through support, consultation, and supervision of staff. (Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series, No. 57. Center for Substance Abuse Treatment (US). Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014.)
Adopting a trauma-informed approach is not achieved through the use of any single technique, methodology, framework or checklist. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level. Finding professional development resources and discussing trauma informed care with colleagues and within professional networks can help build awareness and skills to be able to provide the best and most effective treatment for all our clients in search of recovery.